Tailored psychotherapy for patients with functional neurological symptoms: A pilot study ☆ Markus Reuber a, ⁎ , Christine Burness b , Stephanie Howlett b , John Brazier c , Richard Grünewald b a Academic Unit of Neurology, Division of Genomic Medicine, University of Sheffield, Royal Hallamshire Hospital, Sheffield, United Kingdom b Department of Neurology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, United Kingdom c School of Health and Related Research, Regent Court, Sheffield, United Kingdom Received 2 February 2007; received in revised form 14 May 2007; accepted 19 June 2007 Abstract Objective: The objective of this study was to assess whether individually tailored psychotherapy for patients with functional neurological symptoms is associated with improvements in patient-centered measures of emotional well-being, quality of life, as well as somatic symptoms and whether this treatment modality is likely to be cost-effective. Methods: We conducted an uncontrolled prospective pilot study of consecutive patients with functional symptoms referred from neurology outpatient clinics to a single psychotherapist using validated questionnaires [Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM), Short Function (SF)-36 Health Survey, and Patient Health Questionnaire (PHQ)-15]. Patients had a median of 6 treatment sessions (range=1–24). Ninety-one patients completed questionnaires at referral, 63 did at the end of treatment, and 34 did at follow-up after 6 months. Significant improvements were seen on all measures and were maintained at follow-up (CORE- OM, P=.003; SF-36, Pb .001; PHQ-15, P=.001). Significance was not lost in an intention-to-treat analysis. Of all the patients, 49.2% improved by at least 1 S.D. in at least one of the measures. The number of patients needed to be treated to see an improvement of at least 1 S.D. in one of the three outcome measures was 2; that in two measures, 3.9; and that in all measures, 7. The mean cost of the intervention was £231; the cost per quality-adjusted life year was estimated as £5,328. Results: Psychotherapy was associated with significant improvements in patient-centered measures, which seemed to be achieved at a comparatively low cost. Conclusions: The results indicate that psychotherapy may be a cost-effective intervention for patients presenting with functional neurological symptoms. The findings warrant further assessment of this treatment with a randomized and controlled trial. © 2007 Elsevier Inc. All rights reserved. Keywords: Functional symptoms; Dissociative disorder; Neurology; Nonepileptic seizures; Psychotherapy; Somatoform disorder Introduction Functional neurological symptoms are distressing and resemble manifestations of organic disorders of the nervous system but are medically unexplained. Functional symptoms represent one of the most common reasons for seeking neurological advice. For instance, among 300 consecutive neurological outpatients, symptoms were “not all explained by organic disease” in 11% and only “somewhat explained” in 19% [1]. These make unexplained symptoms about as frequent as headaches (21%) and seizures (14%) and more frequent than all other diagnostic categories, including multiple sclerosis (10%), neuropathies (8%), syncope (7%), spinal pathology (7%), and Parkinson's disease (2%) [2]. Although the absence of a neurological explanation for functional symptoms does not prove that patients have a mental disorder, most fulfill the diagnostic criteria of a somatoform disorder (physical symptoms that suggest a Journal of Psychosomatic Research 63 (2007) 625 – 632 ☆ This study was undertaken at the Sheffield Teaching Hospitals NHS Foundation Trust Department of Neurology. ⁎ Corresponding author. Academic Unit of Neurology, Division of Genomic Medicine, University of Sheffield, Royal Hallamshire Hospital, Glossop Road, S10 2JF Sheffield, United Kingdom. Tel.: +44 0114 2268763; fax: +44 0114 2713684. E-mail addresses: markus.reuber@sth.nhs.uk (M. Reuber), chrissieburness@sth.nhs.uk (C. Burness), stephanie.howlett@sth.nhs.uk (S. Howlett), j.e.brazier@sheffield.ac.uk (J. Brazier), richard.grunewald@sth.nhs.uk (R. Grünewald). 0022-3999/07/$ – see front matter © 2007 Elsevier Inc. All rights reserved. doi:10.1016/j.jpsychores.2007.06.013